Role of Robotic-Assisted Laparoscopic Radical Prostatectomy in the Management of Prostate cancer

Prostate cancer is the second most common malignancy affecting men in the United States, prostate cancer responsible for more than 186,000 new cases and 28,000 deaths in 2008 alone.Radical prostatectomy is the only treatment for localized prostate cancer that has shown a cancerspecific survival benefit when compared to conservative management in a prospective, randomized trial.The first radical perineal prostatectomy was performed by Hugh HamptonYoung in 1904. Millin first described the radical retro pubic approach in1945. However, the procedure remained unpopular because of frequent complications of incontinence and impotence.In 1982, Walsh and Donker described the anatomy of the dorsal venous complex and the neurovascular bundles. This resulted in a significant reduction in blood loss and improved continence and potency rates.To overcome the complication of open surgery the first successful laparoscopic radical prostatectomies were performed by Schuessler in 1992. Robotic assisted radical prostatectomy provides several advantages over conventionallaparoscopic approachsuch as precise dissection through improved instrument control with articulating tips, 3-dimensional vision and magnified view (10x), intuitive eye-hand coordination, motion scaling and filter of tremor. However, the best benefit offered by the surgical robotic is minimizing the steep learning curve set by the conventional laparoscopic approach for radical prostatectomy.